Healthcare Provider Details

I. General information

NPI: 1689562159
Provider Name (Legal Business Name): MICHELLE NADEAU PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 STATE ROUTE 33
NEPTUNE NJ
07753-4859
US

IV. Provider business mailing address

2172 PINNACLE CIR S
PALM HARBOR FL
34684-1761
US

V. Phone/Fax

Practice location:
  • Phone: 732-897-3600
  • Fax: 732-897-3660
Mailing address:
  • Phone: 413-386-4398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00948200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: